Acute Bronchiolitis

Essentials for Dx
1. Insidious onset of cough and dyspnea
2. Irreversible airflow obstruction of PFT
3. Minimal findings on CXR
4. Risk Factors
  Anmerkungen:
  - Toxic fumes, viral infections, organ transplantation, connective tissue disease
Pathophysiology
1. Inflammation of bronchioles
2. VIRAL
  1. Respiratory Syncytial Virus (RSV)
  2. Other
    Anmerkungen:
    - Rhinovirus, adenovirus, influenza, parainfluenza
Risk Factors
1. Infants 2 mo.-2yr.
2. Other
  Anmerkungen:
  - <6 mo, exposure to cigarette smoke, lack of breastfeeding, premature birth (<37 weeks), crowded conditions
Presentation
1. Viral Prodrome
  Anmerkungen:
  - Fever, HA, nausea and vomiting, lethargy, myalgias; lasts 1-2 days
  1. Followed by: Respiratory Distress
    Anmerkungen:
    - Wheezing, rales, tachypnea, nasal flaring, cyanosis, retractions
Diagnosis
1. CLINICAL Dx
2. Pulse Oximetry
  Anmerkungen:
  - Single best predictor in children
3. Nasal Washings
  Anmerkungen:
  - Using monoclonal antibody testing
4. No imaging
  Anmerkungen:
  - CXR shows as nonspecific
Management
1. Supportive care
  Anmerkungen:
  - Humidified O2, IV fluids, nebulized saline, cool mist humidifier, antipyretics
2. If severe
  1. Mechanical Ventilation
3. Immunosuppressed or heart/lung disease
  1. Ribavirin
4. Medications
  Anmerkungen:
  - Limited role
  1. Beta-agonists
  2. Nebulized racemic epinephrine
  3. Corticosteroids*
    Anmerkungen:
    - *Not indicated unless hx of underlying reactive airway disease
5. Prevention
  1. At High Risk: Palivizumab and HANDWASHING
    Anmerkungen:
    - -During the first year of life for children <29 weeks -Symptomatic chronic lung disease of prematurity -Coronary heart disease (CHD) -Neuromuscular difficulties, immunodeficiency
Prognosis/Complications
1. Various complications possible, including d/t tx
  Anmerkungen:
  - Various complications are possible including those caused by therapy. In most cases, the disease is mild and self-limited.
2. RSV bronchiolitis in immunosuppressed infants
  Anmerkungen:
  - In immunosuppressed infants and those with preexisting heart or lung disease, RSV bronchiolitis can result in any of the following:
  - Acute ARDS, Bronchiolitis obliterans, CHF, Secondary infection, Myocarditis, Arrythmias Chronic lung disease

Nächster

Acute Bronchiolitis

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